Low back pain treatment adherence barriers in Eswatini private physiotherapy practices: A pilot study.

Abstract

Background: Adherence to management regimes is pivotal to successfully managing patients with low back pain (LBP). Barriers decrease adherence, resulting in disability.

Objectives: Our pilot study aimed to determine barriers associated with physiotherapy treatment attendance and home exercise programme adherence among patients with LBP and treating physiotherapists in Eswatini.

Method: A cross-sectional descriptive pilot study using a self-developed Research Electronic Data Capture (REDCap) survey was conducted with 62 LBP patients. Descriptive, regression and bivariate statistical analyses with odds ratios (OR) were used to identify adherence barriers.

Results: Twenty-two (35.5%) participants missed appointments because of feeling better. Twenty-one participants (33.9%) missed scheduled appointments due to painful sessions, cost and the burden of changing their routines. Home exercise adherence was positively associated with understanding the condition (p = 0.001) and negatively with too many exercises (p = 0.005).

Conclusion: Our study identified patient barriers to physiotherapy adherence, particularly females aged 40-69 years. Although doctor referrals improved adherence, time constraints and pain remained significant barriers. Barriers to prescribed home exercise programme adherence included pain during exercises, fear, no time, forgetting/no reference and too many exercises. While most participants understood their condition, some lacked understanding, underscoring the need for better education. Addressing these barriers could enhance adherence and reduce the impact of LBP.

Clinical implications: To overcome the barrier of adherence to keeping appointments, prioritising health education and providing reasons for exercises should be empathised. Exercise programme adherence could be improved by providing reference material, less and more meaningful and/or functional exercises.